SUMMARY

• Result - driven Information Technology professional with 5 years of experience as a Business Analyst, Business Consultant in the Healthcare Industries.
• Extensive knowledge of Software Development Life Cycle SDLC methodology worked on Agile, Waterfall and RUP, and Scrum Framework.
• Experience in networking with individuals at various levels and facilitating elicitation sessions for Surveys, Interviews, Interface Analysis including Focus Groups and Brainstorming. Successfully gathered SMART pre-requisites from various stakeholders and users and converted the needs of business users and stakeholders into Functional Requirements Specifications.
• Experience in conducting As-Is and To-Be Analysis and possess strong knowledge in carrying out processes for Risk Analysis, SWOT analysis, Change Management and perform Feasibility Study.
• Experienced in Membership, Billing and Claims Payment Processing in relation to HIPAA 4010/5010 X12, EDI codes 834, 837, 835, 270/271, 276/277, 820 and ICD-9/ICD-10, CPT, HCPCS
• Extensive experience with claim transactions such as 834 (Benefit and Enrollment), 835 (Billing Pay and Remittance), 837 (Submit Medical Claims).
• Well versed with various types of health insurance programs such as: Medicaid, Medicare (Part A, B, C and D), HMO, PPO, and POS,
• Strong knowledge in Care Management and Utilization Management.
• Participated in Scrum Ceremonies such as Daily Scrum, Scrum Retrospective, Sprint Planning, Sprint Review. Facilitate requirements grooming session to redefine the User stories.
• Proficient in creating Request for Proposal (RFP), Business Requirement Document (BRD), Functional Requirement Document (FRD), System Requirement Specification (SRS), Requirement Traceability Matrix (RTM).
• Proficient in creating UML diagrams like Class Diagrams, Activity Diagrams, use case Diagrams and Sequence Diagrams in addition to creating Mockups and Wireframes using tools such as MS Visio, Mockup Screens to communicate requirements to Development and UI teams.
• Maintained Sprint Burn-down chart, Product Release Chart, White Board in JIRA to keep track of the team’s progress and the team’s velocity for better estimation of the sprint’s deliverables. Proficient in writing User Stories and Acceptance Criteria and handling Requirement Churn.
• Knowledgeable working with ETL process Extract, Transform and Load of data into a data warehouse.
• Executed SQL queries for testing and report/data validation.
• Good experience in the EDI transactions and knowledge on EDI transaction process flows.
• Strong experience and understanding of health care industry, claims management process, Knowledge of Medicaid and Medicare Services.
• Knowledge and expertise in working with Claims, Provider, Enrollment, Finance, Benefits, and Vendor Management Business Areas.
• Experienced in EDI and HIPAA Testing Privacy with multiple transactions exposure such as Inbound 834Membership Enrollment, 837Institutional, 837Professional, 837 Dental, 835 Claim Payment/Remittance Advise, 270/271 Eligibility Benefit Inquiry/Response, 276/277 Claim Status Inquiry/Response Transactions and testing in Client Server systems and Mainframe Applications.

TECHNICAL SKILLS

Project Methodologies: SDLC, RUP, UML, Agile, Waterfall, Business Modeling

Tools: Microsoft Visio, Rational Rose Platforms, Windows

Testing Tools: Mercury Quality CenterChange Management Tools Rational Clear Quest

Office Tools: MS Project, MS Office, MS Visio

Version Control Systems: Rational Clear Case

Database: MS SQL Server, MS Access, and Oracle

Reporting Tools: Crystal report XI, Tableau

PROFESSIONAL EXPERIENCE

Confidential, Hartford, CT

Business Analyst

Responsibilities:

• Worked on Member Management, Eligibility, Claims, and Provider modules within FACETS
• Conducted extensive analysis on migration and conversion of Provider and Member data, Group configurations, premium billing, from Legacy system to Claims Engine.
• Developed End-to-End Business Process Flows for HIPAA 5010 EDI transactions including 834 (Benefit Enrollment and Maintenance).
• Worked on solving the errors of EDI 834 load to Facets through MMIS.
• Used Agile Methodology for the Software Development Life Cycle.
• Proficient in using JIRA to log user stories, epics and acceptance criteria.
• Prioritized the spring and product backlogs directly working with the product owner and scrum master.
• Gathered high level requirements from the product owner and coordinated with the scrum master to conduct sprint meetings.
• Involved in documenting the business process by identifying the requirements and involved in finding the system requirements.
• Actively involved in process flow analysis EDI 834for content management system.
• Reviewed and gathered requirements from the Subject Matter Experts (SME) and Business Partners using various elicitation techniques and create Scope Management Documents,
• Worked in creating interfaces for various external vendors.
• Facilitated Joint Application Development (JAD) sessions with all IT group members for communicating & managing expectations and to discuss various means for integrations with current system using an adoption through execution strategy.
• Wrote multiple Test-Cases for transactions include 837, 835.
• Conducted JAD/RAD sessions and elicited customer requirements by organizing interviews with internal/external stakeholders and subject matter experts (SMEs).
• Facilitated data mapping activities and helped with the expansion of membership and provider data model
• Created workflow diagrams, process flow and data flow diagrams
• Assisted team with Data Mapping and Data Extracting Strategies for data migration.
• Checked the data flow through the front end to backend and used SQL queries, to extract the data from the database.
• Involved in Database testing by writing SQL queries.
• Clarified QA team issues and reviewed test plans and test scripts developed by development team and QA team to make sure all requirements have been covered in scripts and tested properly.

Confidential - Omaha, NE

Business Analyst

Responsibilities:

• Responsible for Business Requirements of systems that worked primarily with End User; optimizing current system.
• Interfaced between Business Users and the different teams involved in the application development for better understanding of the business and IT processes
• Conducted JAD sessions for requirement gathering and analysis
• Requirements dealt directly with Claim operations, Claim Status, Eligibility and Benefits
• Conducted GAP Analysis and formulated the TO-BE features based on the business requirements.
• Validated data using SQL and Excel as well as personal data skills.
• Extensively used SQL scripts/queries for data verification and validation
• Identified and defined technical specifications in liaison with the development team for system design, coding and testing.
• Assisted in writing efficient and effective Test Plans, Test Strategy in User Acceptance testing.
• Provided the required test data for the developers in order to fix the defects.
• Participated in QA team meeting and bug tracking meetings.
• Involved in implementation of HIPAA EDI Transactions (835,837)
• Performed GAP Analysis for HIPAA 4010 and 5010 transactions.
• Used EDI tools to verify mapping to X12 format.
• Analyzed HIPAA EDI transactions in X12 responses and of 837, 835, 277 and 999 and looked for defects.
• Provided the required test data for the developers in order to fix the defects.
• Participated in QA team meeting and bug tracking meetings.

Environment: Agile, MS Office Suite, MS TFS, MS VISIO, SQL server.

Confidential, Atlanta, GA

Business Analyst

Responsibilities:

• Responsible for requirements analysis, design and developing technical requirements.
• Performs in-depth investigation, analysis, and evaluation to determine project feasibility.
• Conduced Joint Application Development (JAD) sessions and walk in interview with the business users to gather requirements.
• Matched the requirements for programs such as Medicare and Medicaid, which are part of the Social Security Act.
• Created Use Cases diagram and Activity diagram to depict the interaction between the various actors and the system in Rational Rose for the Business Use Case and System Use Case.
• Organized regular status meetings with vendor to identify accomplishments and any issues that need to be addressed.
• Analyzed forms and successfully crosswalk details to corresponding ANSI X12 formats.
• Worked with HIPAA compliant ANSI X12 837 formats for both professional claims and institutional claims.
• Assisted Business User during deployment in formulating User Acceptance Testing (UAT) for customized application and getting confirmation for product Release.
• Involved in preparing UML diagrams, Business Process Flows, and Activity Diagrams using Microsoft Visio.
• Worked with the business/functional unit to assist in the development, documentation, and analysis of functional and technical requirements within FACETS.
• Assisted in Regression Test, System Test, and UAT
• Performed Migration and Validation per SDLC standards. Interacted with the Test Team and reviewed test Cases.
• Worked with all Facets Provider of software development from requirements gathering to testing, configuration and international deployment.
• Worked in Facets Application Groups Claims Processing, Guided Benefit Configuration, Medical Plan, Provider, Subscriber/Member, Utilization Management, automated claim processing, Provider management.

Tools: Technologies: RUP, SQL, MS Office, MMIS, MS Visio, SharePoint, Lotus Notes, Rally. Rational Tools